Impaction technique and graft treatment in revisions of the femoral component: laboratory studies and clinical validation.

The micromotions of femoral stems cemented into impacted bone-graft were studied in 23 femora from adult sows. The model was validated against 2 patient groups. Conventional impaction technique and a new impaction technique using polished and rotating impactors were studied in the preclinical model and in 14 and 10 patients with type II defects. The specimens were loaded in an MTS (Minneapolis Testing System) machine for 72,000 cycles at 250N to 3,250N. The bone-graft was rinsed in tepid water, and most of the bone marrow and fat were removed. Radiostereometric measurements revealed small subsidence of the stems cemented into the specimens and the patients 6 weeks after the operation without any difference (median values, -0.06 to -0.16 mm). Further studies of specimens operated with nontreated bone-graft showed that extraction of fat increased the stability. Our findings suggest that the early postoperative implant stability after impaction grafting of the femur mainly is an effect of surgical technique and graft treatment. The new impaction technique, with which we hoped to obtain a more reproducible procedure and less risk for perioperative fracture, resulted in stability equal to that obtained with the conventional technique.